CT 灌注成像及血清学指标在肝纤维化诊断中的研究

摘要

目的：探讨 CT 灌注成像与血清学指标对兔肝纤维化进行早期诊断的价值。方法采用四氯化碳法建立肝纤维化模型，对40只肝纤维化成模兔及10只对照兔行灌注成像，取得不同肝纤维化级别肝灌注参数，包括肝动脉灌注量（ALP）、门脉灌注量（PVP）、肝动脉灌注指数（HPI）、血流量（BF）、血容量（BV）。检测肝纤维化兔血清透明质酸（HA）、Ⅲ型前胶原（PCⅢ）、IV 型胶原（IV-C）和层黏连蛋白（LN）值，随后行病检根据肝纤维化诊断评估标准进行分期分组，分析组间灌注参数值，同时分析灌注参数及血清学指标与肝纤维化程度的相关性。结果随着肝纤维化分期增加，PVP 值呈下降趋势（P ＜0．05）；S0、S1期分别与 S2、S3、S4期差异有统计学意义（P＜0．05）；PVP、HPI 与肝纤维化分期存在一定相关性（r ＝-0．84，P ＜0．05；r ＝0．62，P ＜0．05）。血清学指标HA、PCⅢ、IV-C 和 LN 随着肝纤维化程度加重而逐渐升高，HA、IV-C 与肝纤维化分期关系较为密切（P ＜0．05）。结论双源 CT 灌注成像与血清学检查对于判断肝纤维化程度各有优缺点，联合应用二者有助于临床对肝纤维化进行合理评价。%Objective To explore the value of evaluating the stage of liver fibrosis using dual-source CT per-fusion paramaters and serum makers.Methods Intraperitoneal injection of CCl4 was used to induce liver fibrosis.46 rabbits in experimental group and 10 rabbits of control group were examined with dual-source CT perfusion imaging.Perfusion parameters including arterial liver perfusion (ALP),portal venous perfu-sion (PVP),hepatic perfusion index (HPI),blood flow (BF),blood volume (BV)along with serum fi-brosis markers:hyaluronic (HA),laminin (LN),Procollagen typeⅢ (PCⅢ),Ⅳcollagen (Ⅳ-C)were a-chieved and compared with the different groups proved by pathology.All the perfusion parameters and ser-um makers were compared with the severity of fibrosis.Results PVP decreased as the increase of liver fi-brosis.PVP between S0 ,S1 stage to S2,S3,S4 stage were significant different (P <0.05).The perfusion parameters as PVP and HPI showed little relationship with the severity of fibrosis (r =-0.84,P < 0.05;r =0.62,P <0.05).The serum makers,especially HA,Ⅳ-C,was positively correlated with histopatho-logical staging (P <0.05).Conclusion Dual- source CT perfusion and serum markers of fibrosis both have their own benefit and weakness in evaluating liver fibrosis degrees.Thus,combination two of them can improve the evaluation of liver fibrosis.